Provider Demographics
NPI:1689835852
Name:JCOL
Entity Type:Organization
Organization Name:JCOL
Other - Org Name:FAMILY MANORS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:FAITH
Authorized Official - Middle Name:
Authorized Official - Last Name:FELICIANO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:772-288-4781
Mailing Address - Street 1:3385 SE EVERGREEN AVE
Mailing Address - Street 2:
Mailing Address - City:STUART
Mailing Address - State:FL
Mailing Address - Zip Code:34997-5379
Mailing Address - Country:US
Mailing Address - Phone:772-288-4781
Mailing Address - Fax:772-288-4892
Practice Address - Street 1:3385 SE EVERGREEN AVE
Practice Address - Street 2:
Practice Address - City:STUART
Practice Address - State:FL
Practice Address - Zip Code:34997-5379
Practice Address - Country:US
Practice Address - Phone:772-288-4781
Practice Address - Fax:772-288-4892
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:JCOL
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-06-20
Last Update Date:2008-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAL7787310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility